Basic Information
| Provider Information | |||||||||
| NPI: | 1487295358 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORLIN | ||||||||
| FirstName: | DEVIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5850 FLORIDA BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708064247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252010696 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5850 FLORIDA BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708064247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252010696 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2019 | ||||||||
| LastUpdateDate: | 10/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3747P1801X | Y | Nursing Service Related Providers | Technician | Personal Care Attendant |
No ID Information.